Provider Demographics
NPI:1306850672
Name:ANGIELCZYK, COLLEEN A (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:ANGIELCZYK
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9407
Mailing Address - Country:US
Mailing Address - Phone:716-655-5019
Mailing Address - Fax:716-655-1567
Practice Address - Street 1:7531 SENECA ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9407
Practice Address - Country:US
Practice Address - Phone:716-655-5019
Practice Address - Fax:716-655-1567
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001747-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020029302OtherUNIVERA
NY9512978OtherIHA
NY000570158005OtherHEALTLH NOW
NY161000580OtherNOVA
NY161000580OtherNOVA
NY00020029302OtherUNIVERA